Provider Demographics
NPI:1447828199
Name:SOWELLS, WANDA RAE
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:RAE
Last Name:SOWELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 STEPHENS CIR NW APT 303
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3627
Mailing Address - Country:US
Mailing Address - Phone:330-412-5896
Mailing Address - Fax:
Practice Address - Street 1:2728 EUCLID AVE STE 400
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2429
Practice Address - Country:US
Practice Address - Phone:216-236-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator